Peg-IFN and ribavirin treatment for recurrence of genotype 2 and 3 hepatitis C after liver transplantation
(2015) In Scandinavian Journal of Infectious Diseases 47(4). p.209-217- Abstract
- Background: Relapse of hepatitis C virus (HCV) infection after liver transplantation (LT) is universal. Tolerance for treatment with pegylated-interferon (peg-IFN) and ribavirin (RBV) is suboptimal and withdrawals due to adverse events frequent. We sought to improve tolerance for treatment to improve outcome. Methods: We used concentration-guided RBV dosing to achieve an intended 10 mu mol/L concentration with darbepoetin support in combination with peg-IFN alfa-2a, 180 mu g for genotype 1 and 135 mu g for genotype 2/3 to improve tolerance. Results: A total of 51/54 patients (94%) completed a full treatment course. In the per-protocol analysis 43% of patients (22/51) achieved sustained virological response (SVR), 82% with HCV genotype 2/3... (More)
- Background: Relapse of hepatitis C virus (HCV) infection after liver transplantation (LT) is universal. Tolerance for treatment with pegylated-interferon (peg-IFN) and ribavirin (RBV) is suboptimal and withdrawals due to adverse events frequent. We sought to improve tolerance for treatment to improve outcome. Methods: We used concentration-guided RBV dosing to achieve an intended 10 mu mol/L concentration with darbepoetin support in combination with peg-IFN alfa-2a, 180 mu g for genotype 1 and 135 mu g for genotype 2/3 to improve tolerance. Results: A total of 51/54 patients (94%) completed a full treatment course. In the per-protocol analysis 43% of patients (22/51) achieved sustained virological response (SVR), 82% with HCV genotype 2/3 and 22% with genotype 1, p = 0.0001. Patients with IL28B CC achieved SVR in 73% (8/11) and patients with non-CC in 33% (14/43), p = 0.016. Patients with mild fi brosis (fi brosis stage 1-2) achieved SVR in 56% (15/27), and patients with advanced fi brosis (fi brosis stage 3 -4) in only 26% (7/27), p = 0.0267. Conclusions: Concentration-guided RBV dosing with darbepoetin support substantially improves tolerance and offers high adherence to a full peg-IFN and RBV treatment course in patients with post-transplant HCV relapse. With this approach genotype 2 and 3 infections can be treated cost-effectively post-transplant. Genotype 1, IL28B non-CC genotype, and advanced fi brosis predicted a low SVR rate. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/7422898
- author
- Ackefors, Malin ; Castedal, Maria ; Dahlgard, Olav ; Verbaan, Hans LU ; Gjertsen, Henrik ; Wernerson, Annika and Weiland, Ola
- organization
- publishing date
- 2015
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- HCV, peg-IFN, ribavirin, liver transplantation, chronic HCV
- in
- Scandinavian Journal of Infectious Diseases
- volume
- 47
- issue
- 4
- pages
- 209 - 217
- publisher
- Informa Healthcare
- external identifiers
-
- wos:000354545500003
- pmid:25650729
- scopus:84983196957
- ISSN
- 1651-1980
- DOI
- 10.3109/00365548.2014.984322
- language
- English
- LU publication?
- yes
- id
- d742f209-343c-4d2f-b528-c57e638dfb65 (old id 7422898)
- date added to LUP
- 2016-04-01 13:54:45
- date last changed
- 2022-04-14 03:54:55
@article{d742f209-343c-4d2f-b528-c57e638dfb65,
abstract = {{Background: Relapse of hepatitis C virus (HCV) infection after liver transplantation (LT) is universal. Tolerance for treatment with pegylated-interferon (peg-IFN) and ribavirin (RBV) is suboptimal and withdrawals due to adverse events frequent. We sought to improve tolerance for treatment to improve outcome. Methods: We used concentration-guided RBV dosing to achieve an intended 10 mu mol/L concentration with darbepoetin support in combination with peg-IFN alfa-2a, 180 mu g for genotype 1 and 135 mu g for genotype 2/3 to improve tolerance. Results: A total of 51/54 patients (94%) completed a full treatment course. In the per-protocol analysis 43% of patients (22/51) achieved sustained virological response (SVR), 82% with HCV genotype 2/3 and 22% with genotype 1, p = 0.0001. Patients with IL28B CC achieved SVR in 73% (8/11) and patients with non-CC in 33% (14/43), p = 0.016. Patients with mild fi brosis (fi brosis stage 1-2) achieved SVR in 56% (15/27), and patients with advanced fi brosis (fi brosis stage 3 -4) in only 26% (7/27), p = 0.0267. Conclusions: Concentration-guided RBV dosing with darbepoetin support substantially improves tolerance and offers high adherence to a full peg-IFN and RBV treatment course in patients with post-transplant HCV relapse. With this approach genotype 2 and 3 infections can be treated cost-effectively post-transplant. Genotype 1, IL28B non-CC genotype, and advanced fi brosis predicted a low SVR rate.}},
author = {{Ackefors, Malin and Castedal, Maria and Dahlgard, Olav and Verbaan, Hans and Gjertsen, Henrik and Wernerson, Annika and Weiland, Ola}},
issn = {{1651-1980}},
keywords = {{HCV; peg-IFN; ribavirin; liver transplantation; chronic HCV}},
language = {{eng}},
number = {{4}},
pages = {{209--217}},
publisher = {{Informa Healthcare}},
series = {{Scandinavian Journal of Infectious Diseases}},
title = {{Peg-IFN and ribavirin treatment for recurrence of genotype 2 and 3 hepatitis C after liver transplantation}},
url = {{http://dx.doi.org/10.3109/00365548.2014.984322}},
doi = {{10.3109/00365548.2014.984322}},
volume = {{47}},
year = {{2015}},
}